ABSTRACT
This chapter focuses on the healthcare system on a higher level, the most important trends, and their implications for the pharmaceutical market, rather than the individual flavor-of-the-day Trump executive order. Healthcare in the United States (US) is mainly administered through private insurance or managed care organizations (MCOs) and government-run Medicare and Medicaid bodies. Through the combination of emerging high deductible health plans and the healthcare exchanges under Affordable Care Act, close to 20% of the US population is carrying health insurance with relatively high deductibles and co-payments. Prescription drug coverage is provided as part of comprehensive healthcare coverage for most MCOs. Management of biologics, particularly in oncology, has been and continues to be a difficult matter for healthcare plans. High-cost drugs are generally subject to increased scrutiny by healthcare plans through a prior authorization process, requiring the approval by the plan before a script can be filled at the pharmacy or can be used in an inpatient or office setting.
